Food allergy and intolerance (and coeliac disease): what’s the difference?

If you’re working in a food business, it’s not enough to know that someone has “a dietary need.” You need to understand the difference between food allergy and intolerance and also coeliac disease and how to respond safely and confidently.

The broader term food hypersensitivity is being used more often now, instead of just saying food allergy, coeliac disease or food intolerance. It’s used to describe people who experience an adverse physical reaction to food that is otherwise harmless. They can be referred to as the Food Hypersensitive Customer.

Let’s now look at the difference between a food allergy, a food intolerance, and coeliac disease. These terms are often used interchangeably by customers, and even by staff. But understanding the difference between food allergy and intolerance (and coeliac disease) is critical. Once you understand the differences, you’ll find it much easier to speak to customers and most importantly, to prepare food safely for them.

What is a food allergy?

A food allergy is when the immune system overreacts to a protein in food and treats it as a threat. The body releases chemicals, such as histamine, which trigger an allergic reaction.

Reactions can vary from mild to life-threatening. Even a small amount of the allergen can cause a serious response, which is why accurate allergen information and avoiding cross-contamination is so important.

Let’s look at the different parts of the body that can be affected:

• The skin: causing itching, hives, rashes, eczema, redness or swelling, especially around the mouth, face, throat. Also, tingling or itching in the mouth and difficulty swallowing.
• The respiratory system: causing sneezing, coughing, wheezing or hay fever-like symptoms.
• The digestive system: causing stomach pain, nausea, vomiting and diarrhoea.
• And the cardiovascular system: causing dizziness and fainting.

Then there’s anaphylaxis, which is a severe, life-threatening allergic reaction. This is a medical emergency.  Symptoms of anaphylaxis include: a persistent cough, vocal changes, difficulty breathing, wheezing, a racing heartbeat, feeling faint or panicked, clammy skin and in serious cases, collapse or loss of consciousness.

It’s important to remember that someone might have had only mild reactions in the past, but that doesn’t mean the next one won’t be more severe. Reactions can vary from person to person, and even from one exposure to the next. And next time could be in your business. During your shift. From a meal you’ve prepared or served.

There are lots of factors that can affect the severity of a reaction including the individual and the severity of their allergy. Also, things like the amount of allergen, whether the person has asthma, if they’ve drunk alcohol, have carried out exercise or even if they’re feeling tired, stressed, or fighting off an infection.

What is a food intolerance?

A food intolerance doesn’t involve the immune system. Instead, it’s usually caused by a problem with digestion. The person’s body might not be able to properly break down certain foods, which leads to uncomfortable symptoms.

Common symptoms include:

• Bloating or stomach pain
• Wind and diarrhoea
• Tiredness, headaches, brain fog
• Skin issues or joint pain

The symptoms of food intolerance are not usually life-threatening, but they can be debilitating for the sufferer and can last for days or weeks.

Let’s look at an example to illustrate the difference between a food allergy and a food intolerance:

Lactose intolerance is caused by the body’s inability to digest lactose (milk sugar). Lactose intolerance is not the same as a milk allergy.  Milk allergy is caused by a reaction to the protein in milk. So beware, products such as lactose-free milk contain milk protein and would not suitable for someone with a milk allergy. This is why it is very important to speak with customers and provide them accurate information.

What is coeliac disease?

Let’s bust a common myth: Coeliac disease is not a food allergy. And it’s not a food intolerance either. It’s an autoimmune condition.

When someone with coeliac disease eats gluten, their immune system attacks the lining of their gut. Over time, this damages the villi (tiny finger-like structures that help absorb nutrients), which can lead to malnutrition, anaemia, and a range of serious long-term health issues such as bowel cancer.

Symptoms of coeliac disease include:

• Diarrhoea, bloating, wind
• Constipation or nausea
• Tiredness, brain fog, anaemia
• Skin problems, headaches, fertility issues

Gluten is a protein found in wheat, rye, barley, spelt and Kumut. Oats are often contaminated with gluten unless specifically labelled gluten-free. So even trace amounts can cause problems for someone with coeliac disease.

Why this matters in foodservice

In a busy kitchen or front of house setting, you might hear a customer say:

“I can’t eat gluten”

“I have a milk allergy”

“I’m dairy intolerant”

It’s your job to take every request seriously. Understanding the difference between food allergy and food intolerance and coeliac disease helps you ask the right questions, give accurate information, and avoid dangerous assumptions.

For example:

• A food labelled as gluten-free might be safe for a coeliac customer or a customer with an intolerance to wheat, but probably would not suitable for someone with a wheat allergy. That’s because if someone has a wheat allergy, even a tiny amount of wheat could cause an allergic reaction.
• A dish that contains lactose-free milk may not be suitable for someone with a milk allergy if it contains milk protein.

Summary of food allergy and intolerance

Whether someone has a food allergy, a food intolerance, or coeliac disease, your response as a food business should be the same: take it seriously, provide accurate information, and make sure your team understands the risk.

Customers are trusting you to keep them safe , and that starts with knowing the difference between food allergy and intolerance and also coeliac disease. Need help training your team? Check out the Level 2 Food Allergen Awareness and Level 3 Food Allergen Management courses.

Want to know more? Check out the Ultimate Allergen Management Guide for UK Foodservice and Hospitality here.